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rtms for Post-Concussion Syndrome (PCS)

Post-Concussion Syndrome (PCS) is a condition that may develop following a concussion, a form of mild traumatic brain injury (mTBI) usually caused by a blow to the head or a sudden movement that causes the brain to shake inside the skull (1). While the majority of individuals recover from a concussion within a few weeks, nearly half of those diagnosed with PCS endure symptoms for up to three months after the injury (2). Moreover, approximately 10% to 15% of patients report experiencing these symptoms for over a year.

 

Common symptoms of PCS include persistent headaches, dizziness, fatigue, irritability, anxiety and depression, memory and concentration problems, sensitivity to light and noise, and sleep disturbances (1).

 

The persistent nature of these symptoms can significantly affect a person’s quality of life (1). The cognitive impacts, such as memory loss and difficulty concentrating, can make it challenging to perform at work or school. Emotional and psychological symptoms, like irritability and depression, can strain personal relationships and lead to social isolation. Physical symptoms like headaches and dizziness can impede daily activities and overall functioning, making even routine tasks difficult. Collectively, these challenges can lead to a diminished sense of well-being and can profoundly affect an individual’s ability to lead a normal, active life.

The underlying causes of Post-Concussion Syndrome (PCS) are not fully understood, but experts believe it involves metabolic dysfunction in the brain affecting the autonomic nervous system and autoregulation of cerebral blood flow (3). Several factors can increase the likelihood of developing PCS including a high symptom burden shortly after the injury, having had multiple concussions in the past, existing mental health issues, longer periods of unconsciousness or memory loss after the injury, and younger age (4).

Without a specific treatment for PCS, management typically focuses on alleviating symptoms (1). This may include medications for headaches, psychological counseling, and psychotropic medications tailored to the individual’s specific complaints and level of disability.

Numerous studies (5-8) have demonstrated that rTMS therapy leads to significant improvements in symptoms of PCS including reduced severity and frequency of headaches, enhanced cognitive function, less sleep disturbance, decreased symptoms of depression and anxiety, and an overall improved quality of life.

Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive, highly effective treatment that uses electromagnetic impulses that pass easily through the skull to stimulate abnormal brain activity without any systematic side effects or downtime.

  1. Taylor, A. A., McCauley, S. R., & Strutt, A. M. (2023). Postconcussional Syndrome: Clinical Diagnosis and Treatment. Neurologic Clinics, 41(1), 161-176.

  2. Rabinowitz, A. R., & Levin, H. S. (2014). Cognitive sequelae of traumatic brain injury. Psychiatric Clinics, 37(1), 1-11.

  3. Haider, M. N., & Bezherano, I. (2019). Post concussion syndrome. In Traumatic Brain Injury-Neurobiology, Diagnosis and Treatment. IntechOpen.

  4. Dwyer, B., & Katz, D. I. (2018). Postconcussion syndrome. Handbook of clinical neurology, 158, 163-178.

  5. Mollica, A., Safavifar, F., Fralick, M., Giacobbe, P., Lipsman, N., & Burke, M. J. (2021). Transcranial magnetic stimulation for the treatment of concussion: a systematic review. Neuromodulation: Technology at the Neural Interface, 24(5), 803-812.

  6. Moussavi, Z., Suleiman, A., Rutherford, G., Ranjbar Pouya, O., Dastgheib, Z., Zhang, W., … & Lithgow, B. (2019). A pilot randomised double-blind study of the tolerability and efficacy of repetitive transcranial magnetic stimulation on persistent post-concussion syndrome. Scientific reports, 9(1), 5498.

  7. Stilling, J., Paxman, E., Mercier, L., Gan, L. S., Wang, M., Amoozegar, F., … & Debert, C. (2020). Treatment of persistent post-traumatic headache and post-concussion symptoms using repetitive transcranial magnetic stimulation: a pilot, double-blind, randomized controlled trial. Journal of neurotrauma, 37(2), 312-323.

  8. Koski, L., Kolivakis, T., Yu, C., Chen, J. K., Delaney, S., & Ptito, A. (2015). Noninvasive brain stimulation for persistent postconcussion symptoms in mild traumatic brain injury. Journal of neurotrauma, 32(1), 38-44.